Improving inappropriate medication and information transfer at hospital discharge: study protocol for a cluster RCT

Autor: Grischott, Thomas, Zechmann, Stefan, Rachamin, Yael, Markun, Stefan, Chmiel, Corinne, Senn, Oliver, Rosemann, Thomas, Rodondi, Nicolas, Neuner-Jehle, Stefan
Přispěvatelé: University of Zurich, Grischott, Thomas
Rok vydání: 2018
Předmět:
Cluster-randomised controlled trial
Time Factors
General Practice
Psychological intervention
Inappropriate Prescribing
Health informatics
Health administration
Study Protocol
Drug Utilization Review
0302 clinical medicine
Cluster Analysis
Electronic Health Records
030212 general & internal medicine
Cluster randomised controlled trial
Hospital discharge
Patient priorities
2718 Health Informatics
Randomized Controlled Trials as Topic
lcsh:R5-920
Communication
Data Collection
Health Policy
Health services research
General Medicine
Middle Aged
Patient Discharge
3. Good health
Hospital Information Systems
Patient Safety
Potentially inappropriate medication
Deprescribing
lcsh:Medicine (General)
11035 Institute of General Practice
Patient Transfer
Medication review
Safety Management
medicine.medical_specialty
610 Medicine & health
Health Informatics
Patient Readmission
03 medical and health sciences
Double-Blind Method
360 Social problems & social services
medicine
Humans
Health policy
Aged
Polypharmacy
business.industry
Public Health
Environmental and Occupational Health
Multimorbidity
2739 Public Health
Environmental and Occupational Health
Patient Acceptance of Health Care
2719 Health Policy
Emergency medicine
business
030217 neurology & neurosurgery
Zdroj: Implementation Science : IS
Implementation Science, Vol 13, Iss 1, Pp 1-11 (2018)
Grischott, Thomas; Zechmann, Stefan; Rachamin, Yael; Markun, Stefan; Chmiel, Corinne; Senn, Oliver; Rosemann, Thomas; Rodondi, Nicolas; Neuner-Jehle, Stefan (2018). Improving inappropriate medication and information transfer at hospital discharge: study protocol for a cluster RCT. Implementation Science, 13(1), p. 155. BioMed Central 10.1186/s13012-018-0839-1
ISSN: 1748-5908
Popis: Background Inappropriate medication and polypharmacy increase morbidity, hospitalisation rate, costs and mortality in multimorbid patients. At hospital discharge of elderly patients, polypharmacy is often even more pronounced than at admission. However, the optimal discharge strategy in view of sustained medication appropriateness remains unclear. In particular, unreflectingly switching back to the pre-hospitalisation medication must be avoided. Therefore, both the patients and the follow-up physicians should be involved in the discharge process. In this study, we aim to test whether a brief medication review which takes the patients’ priorities into account, combined with a standardised communication strategy at hospital discharge, leads to sustained medication appropriateness and extends readmission times among elderly multimorbid patients. Methods The study is designed as a two-armed, double-blinded, cluster-randomised trial, involving 42 senior hospital physicians (HPs) with their junior HPs and 2100 multimorbid patients aged 60 years or older. Using a randomised minimisation strategy, senior HPs will be assigned to either intervention or control group. Following instructions of the study team, the senior HPs in the intervention group will teach their junior HPs how to integrate a simple medication review tool combined with a defined communication strategy into their ward’s discharge procedure. The untrained HPs in the control group will provide data on usual care, and their patients will be discharged following usual local routines. Primary outcome is the time until readmission within 6 months after discharge, and secondary outcomes cover readmission rates, number of emergency and GP visits, classes and numbers of drugs prescribed, proportions of potentially inappropriate medications, and the patients’ quality of life after discharge. Additionally, the characteristics of both the HPs as well as the patients will be collected before the intervention. Process evaluation outcomes will be assessed parallel to the ongoing core study using qualitative research methods. Discussion So far, interventions to reduce polypharmacy are still scarce at the crucial interface between HPs and GPs. To our knowledge, this trial is the first to analyse the combination of a brief deprescribing intervention with a standardised communication strategy at hospital discharge and in the early post-discharge period. Trial registration ISRCTN, ISRCTN18427377. Registered 11 January 2018 Electronic supplementary material The online version of this article (10.1186/s13012-018-0839-1) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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